Transcript
HOW ARE PBMS BREEDING GROUNDS FOR FALSE CLAIMS ACT VIOLATIONS?
Pharmacy Benefit Managers, or PBMs, play a crucial role in the healthcare system. But did you know they can also be breeding grounds for False Claims Act violations?
Hi, I’m Joshua M. Baker, a lawyer at Young Law Group. Let’s talk about how PBMs can become hotspots for fraud under the False Claims Act.
PBMs manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, and large employers. While they aim to control drug costs, their complex operations can sometimes lead to fraudulent activities.
One common issue is rebate misreporting. PBMs negotiate rebates with drug manufacturers but may not fully disclose these rebates to the insurers or the government, leading to inflated costs and potential False Claims Act violations.
Another problem is formulary manipulation. PBMs can favor higher-cost drugs in exchange for larger rebates, which can result in higher expenses for government programs like Medicare and Medicaid.
Finally, there’s the issue of overcharging and kickbacks. PBMs may overcharge for prescription drugs or engage in kickback schemes with pharmacies and drug manufacturers, directly violating the False Claims Act.
If you suspect fraudulent activity within a PBM, it’s crucial to seek legal advice. Whistleblowers play a vital role in uncovering these schemes and protecting government funds